Murphy Tanya K, Parker-Athill E Carla, Lewin Adam B, Storch Eric A, Mutch P Jane
1 Department of Pediatrics, University of South Florida Morsani College of Medicine , Tampa, Florida.
J Child Adolesc Psychopharmacol. 2015 Feb;25(1):57-64. doi: 10.1089/cap.2014.0010. Epub 2014 Oct 9.
Previous studies suggest that the unexplained sudden and severe onset of obsessive-compulsive disorder (OCD) and/or tics may be infection or immune precipitated. Beta lactam antibiotics may be neuroprotective beyond their antimicrobial efficacy. We examine the preliminary safety and efficacy of cefdinir in reducing obsessive-compulsive and/or tic severity in children with new-onset symptoms.
Twenty subjects were randomized to receive placebo or cefdinir for 30 days for the treatment of recent-onset OCD and/or tics. The placebo group received a comparable inactive treatment matched for taste, color, and consistency. The Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) and Yale Global Tic Severity Scale (YGTSS) were the primary outcome measures utilized.
Subjects receiving cefdinir saw notable improvements in tic symptoms, with 44.4% showing at least a 25% reduction in YGTSS (mean decrease=9.5) scores compared with 9.1% of the placebo group (mean decrease=0.13). Despite improvements, significant group differences were not observed for YGTSS (F [1, 13]=4.03, p=0.066) although there were moderate differences between group treatment effects (d=0.72). For OCD symptoms, subjects receiving cefdinir saw improvements in OCD symptoms, with 33.3% showing at least a 25% reduction in CY-BOCS scores (mean decrease=7.8) compared with 27.3% of the placebo group (mean decrease=4.7), but there were also no significant differences for CY-BOCS (F [1, 13]=0.385, p=0.546; d=0.24).
Subjects assigned to cefdinir exhibited notable, albeit nonstatistically significant, improvements in tic symptoms, compared with the placebo group. There were also some improvements in OCD symptoms, although these were not significant. Overall, cefdinir was well tolerated. Given these preliminary results, a fully powered study is warranted to explore the efficacy of cefdinir as a therapeutic tool for new-onset pediatric neuropsychiatric symptoms, particularly those that appear to be precipitated by infection.
先前的研究表明，强迫症（OCD）和/或抽动症无法解释的突然严重发作可能是由感染或免疫因素引发的。β-内酰胺类抗生素可能除了具有抗菌功效外还具有神经保护作用。我们研究了头孢地尼在减轻新发症状儿童的强迫症状和/或抽动严重程度方面的初步安全性和有效性。
20名受试者被随机分为两组，分别接受安慰剂或头孢地尼治疗30天，以治疗近期发作的强迫症和/或抽动症。安慰剂组接受了在味道、颜色和稠度上匹配的类似无活性治疗。主要的疗效评估指标是儿童耶鲁布朗强迫量表（CY-BOCS）和耶鲁综合抽动严重程度量表（YGTSS）。
接受头孢地尼治疗的受试者抽动症状有显著改善，44.4%的受试者YGTSS评分至少降低了25%（平均降低9.5），而安慰剂组为9.1%（平均降低0.13）。尽管有改善，但YGTSS未观察到显著的组间差异（F [1, 13]=4.03, p=0.066），尽管组间治疗效果存在中度差异（d=0.72）。对于强迫症症状，接受头孢地尼治疗的受试者强迫症症状有改善，33.3%的受试者CY-BOCS评分至少降低了25%（平均降低7.8），而安慰剂组为27.3%（平均降低4.7），但CY-BOCS也没有显著差异（F [1, 13]=0.385, p=0.546；d=0.24）。
与安慰剂组相比，接受头孢地尼治疗的受试者抽动症状有显著改善，尽管无统计学意义。强迫症症状也有一些改善，尽管不显著。总体而言，头孢地尼耐受性良好。鉴于这些初步结果，有必要进行一项充分有力的研究，以探索头孢地尼作为治疗新发儿科神经精神症状，特别是那些似乎由感染引发的症状的治疗工具的疗效。
